Organization
NORTHERN ITASCA HOSPITAL DISTRICT
Active
Parent organization
NORTHERN ITASCA HOSPITAL DISTRICT
Other names
Bigfork Valley Pharmacy
Organization subpart
Yes
Provider details
NPI number
Legal business name
NORTHERN ITASCA HOSPITAL DISTRICT
Authorized official
DR. HEATHER LEIGH BIBEAU PHARMD (DIRECTOR OF PHARMACY)
(218) 743-4444
Entity
Organization
Contact information
Practice address
258 PINE TREE DRIVE, BIGFORK, MN 56628-0258
(218) 743-4444
(218) 743-4232
Mailing address
PO BOX 258, 258 PINE TREE DRIVE, BIGFORK, MN 56628-0258
(218) 743-4444
(218) 743-4232
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
261348
MN
3336L0003X
Long Term Care Pharmacy
261348
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
222121700
—
MN
01
—
2421840
NCPDP
MN
01
—
2613482
PHARMACY LICENSE
MN
Enumeration date
02/15/2007
Last updated
03/07/2023
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